HomeMy WebLinkAbout5400 Jonathan Ct - Applications/Air Conditioner - 08/07/2017TX����" Call fob Pq ant
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Ip+�®11 �py�� 281 N. College Ave P.O. Box 580
Collins Fort Collins, CO 80524
Yd ryK� ( Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # B � 1�) L4 S 4 Date $- ?- / 7
For office use only
)ob Site Address (required) Value of Construction (labor, materials, profit)
5 00 :To a h; C- -' $ ' 'A70c>
Property Owner Name
Address
City/State
Zip
Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor #
Address
City/State
Zip
Phone
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Contractor City of R. Collins Sales Tax #
sales
393d1l
Are you paying taxes here or by report? il'Here ❑ Report
tax number isrepuiredbyall contractors.
Are you paying with your trust
account?
es O No
Is this a residential or co� merdal project? Residential ❑ Commercial
If residential, is it: QSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes C3'No If yes, you may need to contact H/storic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with thisapplicadon
Description of work AJ.A 1-)leG12c2E A ,
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:
/List the company name or City of Ft Collins license
Electrician 0 Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: �� t /
Print Name: Signature Date